Osteopenia in young adult survivors of childhood cancer

Background. Improved survival of children with malignant diseases is in par t due to the application of intensive, multimodality therapies, including r adiotherapy, surgery, glucocorticoids, and cytotoxic agents. Such intervent ions have the potential to induce complex hormonal, metabolic and nutrition al effects that may interfere with skeletal mass acquisition during childho od and adolescence: it is possible that such childhood cancer survivors may therefore reach adulthood with diminished peak bone mass and be at increas ed risk for clinically significant osteoporosis later in their life. Proced ure. A bone mineral density (BMD) was measured in 26 unselected former canc er patients attending the Pediatric Long-Term Clinic at M.D. Anderson Cance r Center. BMD was measured at the lumbar spine and the hip using dual X-ray absorptiometry (Hologic QDR-4500W). In addition, the patients' complete me dical records were reviewed with particular attention to disease type, age modalities of treatment, and hormonal residual deficiencies. Results. The m edian age of patients at the time of cancer diagnosis was 8 years (range, 0 .3 to 16 years). Median age at BMD determination was 23 years (range, 18 to 41 years), and the median interval since cancer diagnosis and BMD was 18 y ears (range, 5 to 29). Overall, their BMD was decreased relative to peak bo ne mass at all sites: osteopenia was especially pronounced in patients with a history of cranial irradiation who had developed evidence of pituitary i nsufficiency during childhood or adolescence. Overall, the median BMD T-sco re was -1.41 at the lumbar spine, -1.04 at the femoral neck, and -1.06 for total hip. For patients with prior cranial irradiation, T-score at the lumb ar spine was -2.18 (range, - 4.06 to -0.98), at the if moral neck -1.92 (ra nge, -4.11 to +1.10), and for total hip -1.67 (range, -4.79 to +0.56); BMD for irradiated patients was significantly lower than BMD of patients withou t cranial irradiation. We could not discern an independent impact of other disease characteristics or treatment modalities in this small group of pati ents. Conclusions, Osteopenia is a prominent finding in young adults who ar e survivors of childhood cancers; it is likely that antineoplastic treatmen ts during childhood and adolescence impede peak bone mass acquisition. We s uggest that systematic attention to this potential complication is needed i n order to identify what subgroups of children may require regular surveill ance and what interventions are required for its prevention or treatment. M ed. Pediatr. Oncol, 32:272-278, 1999. (C) 1999 Wiley-Liss, Inc.